Provider Demographics
NPI:1922029362
Name:D & D PHARMA LLC
Entity Type:Organization
Organization Name:D & D PHARMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:DINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-947-2711
Mailing Address - Street 1:14450 GETZ RD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-3303
Mailing Address - Country:US
Mailing Address - Phone:800-947-2711
Mailing Address - Fax:317-776-6723
Practice Address - Street 1:14460 GETZ RD
Practice Address - Street 2:STE 200
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-3303
Practice Address - Country:US
Practice Address - Phone:317-818-1059
Practice Address - Fax:317-818-1094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
IN60006593A3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167450OtherPK
IN200423130Medicaid
IN200423130Medicaid
239650Medicare PIN
IN4793670001Medicare NSC
239650Medicare PIN
IN200423130AMedicaid
IN239650Medicare PIN